Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers.

Background: In recipients of allogeneic hematopoietic-cell transplants, per ipheral-blood cells mobilized with the use of filgrastim (recombinant granu locyte colony-stimulating factor) engraft more rapidly than bone marrow. Ho wever, the relative effects of these techniques on the rates of acute and c hronic graft-versus-host disease, overall survival, and disease-free surviv al have not been determined in randomized studies. Methods: Between March 1996 and July 1999, 172 patients (12 to 55 years of age) with hematologic cancer were randomly assigned to receive either bone marrow or filgrastim-mobilized peripheral-blood cells from HLA-identical re latives for hematopoietic rescue after the treatment of hematologic cancer with high doses of chemotherapy, with or without radiation. Results: The recovery of both neutrophils and platelets was faster with per ipheral-blood cells than with marrow (P<0.001 for both comparisons). The cu mulative incidence of grade II, III, or IV acute graft-versus-host disease at 100 days was 64 percent with peripheral-blood cells and 57 percent with marrow (hazard ratio, 1.21; 95 percent confidence interval, 0.81 to 1.81; P =0.35). The cumulative incidence of chronic graft-versus-host disease was 4 6 percent with peripheral-blood cells and 35 percent with marrow (hazard ra tio, 1.16; 95 percent confidence interval, 0.71 to 1.90; P=0.54). The estim ated overall probability of survival at two years was 66 percent with perip heral-blood cells and 54 percent with marrow (hazard ratio for death, 0.62; 95 percent confidence interval, 0.38 to 1.02; P=0.06). The rate of disease -free survival at two years was 65 percent with peripheral-blood cells and 45 percent with marrow (hazard ratio for relapse or death, 0.60; 95 percent confidence interval, 0.38 to 0.95; P=0.03). Conclusions: In patients given high-dose chemotherapy, with or without radi ation, for the treatment of hematologic cancer, allogeneic peripheral-blood cells used for hematopoietic rescue restore blood counts faster than allog eneic bone marrow, without increasing the risk of graft-versus-host disease . (N Engl J Med 2001;344:175-81.) Copyright (C) 2001 Massachusetts Medical Society.